Challenges in the management of tuberculosis in Nigeria

Talatu Dalihu is one of those medical workers engaged in new contact investigation. She works in the Nasarawa area of Kano State and began her career as a health worker over fifteen years ago.

She became interested in fighting TB when she lost a cousin to TB a couple of years ago. “My cousin death and the bitter experience she passed through made me to take up the challenge to train as TB worker.

I was convinced that if I had had the training to manage a TB patient I would not have loss her to the decease.”– Talatu Dalihu

Working as a contact investigator has become Talatu’s calling in life, she looks for every opportunity she can to find as many people with TB. In January 2018, she was at work in Kano General Hospital, when she met Sadiq Dan-Asabe.

Sadiq has drug-resistant TB and had just been admitted to the hospital to start his treatment. Talatu seized the moment and introduced herself explaining who she was and why it was important that she visited his home to see if anyone living with him was also infected.

The next day Talatu visited Sadiq’s family home and found ten people living in an environment that permits TB to thrives, small living spaces, crammed with people.

TB bacteria become airborne when someone with the disease coughs and can remain in unventilated dark rooms for many hours, which put everyone inside at high-risk of also becoming infected.

Sadiq was living with his two brothers and their wives, his sister Amina and her husband, and four children.

Talatu gathered the family together and explained the reason for her visit, and although none of them said they were experiencing any TB symptoms, she still asked them to provide samples for testing because she wanted to be absolutely sure.

The children were all put on isoniazid preventive treatment (IPT) to stop them from getting TB, and the samples were tested at a local laboratory using a GeneXpert machine purchased by USAID/Challenge TB.

When the test results came back, they showed that Sadiq’s sister Amina had TB and his two brothers Aliyu and Haruna had a form of TB that is drug-resistant. Talatu informed the family of these results and what it meant.

Unlike their brother Sadiq, none of them had any obvious TB symptoms and did not even know they were sick. Thanks to Talatu’s visit all three have now started on the appropriate treatment and are progressing well.

This quick and easy action not only demonstrates how effective contact investigation is but also illustrates its importance.

Without a fast diagnosis, his family would have had less chance of being treated successfully and would have continued to infect those around them, adding further to the epidemic of TB in Nigeria.

Contact investigation is just one method Challenge TB is employing to find people with TB who are being missed by routine health services.

Nigeria is said to be among the 14 high burden countries for Tuberculosis (TB), TB/HIV and multi-drug resistant TB and has also been ranked seventh among the 30 high TB burden countries in the world and second in Africa.

According to the WHO, this has been made worse by the issues of drug resistant TB and the HIV/AIDS epidemic. It has been estimated that 407,000 people in Nigeria contact TB every year. This is the estimated number of HIV negative people.

In addition, there is an estimated 63,000 HIV positive people that get TB every ear. An estimated 115,000 HIV negative people die from TB every year and an estimated 39,000 HIV positive people also die.

It has been said that achieving the reduction in TB incidence rate for attainment of the 90-90-90 target of the END TB strategy will be a mirage, if something drastic is not done.

According to WHO, Tuberculosis happens to be the unprecedented world’s most infectious deadly killer with about 4500 lives lost per day and unfortunately, Nigeria is far worse hit by this global epidemic in Africa.

Nigeria currently ranks 7th in the world and 2nd in Africa among the 30 countries with the highest burden of TB, TB/HIV, multi drug resistant TB. Significant progress has been made in the fight against Tuberculosis, but it continues to be a life-threatening disease that is worsened by many challenges responsible for its prevalence.

Although curable, treatment and diagnosis for Tuberculosis continue to be a matter of global concern, especially in the emergence of multidrug-resistant TB (MDR TB) which poses a major health security threat and jeopardizes long running global efforts to curb the deadly disease.

Most worrisome is the co-infection of TB in people living with HIV (PLHIV). The risk of developing tuberculosis is estimated to be between 16-27 times greater in people living with HIV than among those without

TB has become a challenging development problem because one of the major factors fuelling its prevalence is poverty; sadly, we have about 152m Nigerians living below poverty line.

WHO reports that about 2 million people die from TB yearly and 10.4 million new cases of TB were reported in 2016, with seven countries accounting for 64% of the burden comprising of India, Indonesia, China, Philippines, Pakistan, Nigeria and South Africa.

Sadly, many of these people affected by TB are poor and disadvantaged people who live in impoverished communities with remote access to healthcare and because TB infected persons also experience stigma and discrimination, many TB cases go untreated as transmission of the disease continue unabated and because TB is airborne, the effects are devastating.

In the course of a year, people with active TB can infect 10–15 other people through close contact. Infants, people living with HIV, women and people living in marginalized communities are more at risk of contracting TB.

A bad cough that lasts longer than two weeks, chest pain, fatigue, weight loss, lack of appetite, chills, fever and night sweats are symptoms associated with TB; anyone experiencing these should seek medical care immediately.

In Nigeria, USAID’s Challenge TB project has trained over 338 healthcare workers, across 184 local government areas all of whom are now working as contact investigators and visiting the homes of every person who is diagnosed with TB.

The investigators are taught how to identify people who may have the disease, and how to collect sputum samples that can be sent to testing centers to confirm the diagnosis.

Every year around 20,000 people in Nigeria get sick with drug-resistant TB. The USAID-funded Challenge TB project provides a telephone helpline as well as diagnosis, treatment, and support to TB patients across the country.

Between October 2017 and June 2018, a total of 777 drug-resistant TB patients were diagnosed, and 79 percent started on treatment.